BOF: 17
A 50-year-old male
presents with a history of recurrent episodes of fever of 8 months duration.
He also complains
of discomfort in his right upper abdomen. He gives a history of jaundice and
passage of pale stools in conjunction with the fever.
For the last 2
months he has been having itching of his skin
He gives a history
of having periods where he passes dark urine.
He has had a
cholecystectomy in the past for gallstones.
On examination he
was febrile, pale and icteric.
He was noted to
have white nails, palmar erythema and spider naevi. There were widespread
excoriations of his skin.
Cardiovascular and
respiratory examination was unremarkable. Abdominal examination revealed
hepatosplenomegaly but no ascites.
Urine was positive
for bile
Investigations
Hb 10.0 g/dL
MCV 105
WBC 3.5 x109/L
Platelets 120 x109/L
Bilirubin 63 umol/L
Alkaline phosphatase 34IU/L
Albumin 25g/L
In this patient which one of the
following test would you arrange?
a)
Liver biopsy
b)
ERCP
c)
Blood cultures
d)
ANCA
e)
Reticulocyte count
